SCREEN Yourself for Cancer - NCT07927686

Sponsor: Milton S. Hershey Medical Center Conditions: Colorectal Cancer Screening, Cervical Cancer Screening This randomized controlled trial will evaluate whether evidence-based self-sampling tools improve the cancer screening process among underscreened patients. Participants who are eligible but out-of-date for colorectal cancer screening, cervical cancer screening, or both will be randomized to either usual practice or an intervention that includes mailed self-sampling tools for the appropriate cancer screening test. Primary outcomes include screening initiation (within 12 months of enrollment) and screening completion (within 18 months of enrollment), for each cancer type. Secondary outcomes include repeat screening adherence and receipt of diagnostic resolution following abnormal screening results. In the US, tens of thousands of people die from screen-preventable cancers each year. Failures occur across the entire cancer screening process, from screening initiation, to screening completion (i.e., receipt of a normal screening result or diagnostic resolution after an abnormal result), to repeat screening. Providing patients with self-sampling tools can improve these outcomes. These self-sampling tools (fecal immunochemical test \[FIT\] for colorectal cancer \[CRC\] screening and self-collected human papillomavirus \[HPV\] test for cervical cancer screening) enable patients to collect a sample at home and send it to a lab for testing. These tests are highly accurate and acceptable but not well-integrated into clinical care. Further, their impacts on screening completion and repeat screening are not well-studied. The proposed study is a rigorous, two-arm, parallel-groups randomized controlled trial to assess screening initiation, screening completion, and repeat screening among patients who are eligible but out-of-date with screening for CRC and/or cervical cancer. The study team will generate a census of patients in our healthcare system who meet study inclusion criteria and undertake stratified random selection to select patients for inclusion in the study. Patients will be randomized (1:1) to study arm: Usual practice arm, in which patients receive a letter informing them that they are out-of-date with cancer screening and encouraging them to make an appointment to get screened, and Self-sampling arm, in which patients receive self-sampling tool(s) and are encouraged to use it for cancer screening. As appropriate, patients will receive screening reminders, diagnostic resolution follow-up procedures, and 1-year repeat FIT for CRC screening. The study team will collect data from electronic health records and surveys. The study Aims are as follows: Aim 1: Investigate between-arms differences in screening initiation. Aim 2: Examine between-arms differences in downstream screening outcomes. Aim 3: Identify mediators and moderators that impact the cancer screening process. The recruitment goal for this study is 852 patients, including 542 who are eligible but out-of-date for CRC screening; 110 who are eligible but out-of-date for cervical cancer screening; and 200 who are eligible but out-of-date for both screenings. This sample will support rigorous, well-powered analyses of our Aims and hypotheses, using bivariate and multivariable analyses (including mediation and moderation analysis). This study will demonstrate the impact of self-sampling tools for the entire cancer screening process, which has significant implications for clinical care, public health, and behavioral research. The findings from the proposed study will support our long-term goal of identifying strategies to increase participation in the cancer screening process and to reduce screen-preventable cancer mortality in the US.